Lakewood City Center Dental LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

LAKEWOOD CITY CENTER DENTAL LLC

Practice address

14865 Detroit Ave
Lakewood, OH 44107-3909

Phone

(216) 228-7950

NPI assigned

Jun 29, 2020

Last updated

Jun 29, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Charlyne Jungermann

Title

Practice Manager

Phone

(440) 823-3175

Specialties & licenses 1

Addresses

Electronic endpoints 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Stacy Jacob, DMD

  • General Practice Dentistry
  • Lakewood, OH
  • NPI 1275150013
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1593388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593388800000",
    "number": "1710504592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14865 DETROIT AVE",
            "city": "LAKEWOOD",
            "state": "OH",
            "postal_code": "441073909",
            "telephone_number": "216-228-7950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14865 DETROIT AVE",
            "city": "LAKEWOOD",
            "state": "OH",
            "postal_code": "441073909",
            "telephone_number": "216-228-7950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEWOOD CITY CENTER DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-29",
        "last_updated": "2020-06-29",
        "certification_date": "2020-06-29",
        "status": "A",
        "authorized_official_last_name": "JUNGERMANN",
        "authorized_official_first_name": "CHARLYNE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "440-823-3175"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "lakewoodcitycenter@gmail.com",
            "affiliation": "N",
            "endpointDescription": "lakewoodcitycenter@gmail.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "14865 Detroit Ave",
            "city": "Lakewood",
            "state": "OH",
            "country_code": "US",
            "postal_code": "441073909",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Lakewood Dental Associates LLC (Lakewood Dental)

• Dental Clinic/Center in Lakewood, OH
• Providers in Lakewood, OH by specialty
• Dental Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.